Lin Yuan, Wu Hsin-Kuan, Wang Te-Hsiung, Chen Tien-Hsing, Lin Yu-Sheng
Emergency Medicine Department, Chang Gung Memorial Hospital Keelung Branch, Keelung, Taiwan.
Department of Primary Care and Emergency Medicine, Kyoto University Graduate School of Medicine Faculty of Medicine, Kyoto, Japan.
BMJ Open. 2019 May 30;9(5):e023487. doi: 10.1136/bmjopen-2018-023487.
This study determined the recurrence and complication rates after radiofrequency catheter ablation (RFCA) for those with paroxysmal supraventricular tachycardia (PSVT), Wolff-Parkinson-White syndrome (WPW), atrial flutter (AFL), atrial fibrillation (AF) and ventricular tachycardia (VT).
This retrospective study included RFCAs for 2001-2010 in the Taiwan National Health Insurance Research Database. Primary outcomes included perioperative complications (pericardial effusion and new-onset stroke), RFCA recurrence and long-term outcomes (high-grade atrioventricular block (AVB) and pacemaker implantation).
Of 19,475 patients who underwent RFCA, prevalence rates were 56.7% for PSVT, 13.5% for WPW, 9.5% for AFL, 5.1% for AF and 2.7% for VT. Prevalence rates increased in AF, AFL and VT over the study years. During an average follow-up period of 4.3 years (SD: 2.8 years), recurrence rates for PSVT, WPW, VT, AFL and AF were 2.0%, 4.9%, 5.7%, 5.8% and 16.1%, respectively. Compared with the PSVT group, the WPW and AF groups had significantly higher risk of pericardial effusion during admission (adjusted OR (aOR) 2.98, 95% CI (CI) 1.24 to 7.15; aOR 4.09, 95% CI 1.90 to 8.79, respectively); the AFL group had a higher risk of new-onset stroke during admission (aOR 4.07, 95% CI 1.39 to 11.91); the WPW group had a lower risk of high-grade AVB during follow-up (adjusted HR (aHR) 0.37, 95% CI 0.19 to 0.71) while the AFL group had a greater risk (aHR 1.74, 95% CI 1.17 to 2.60); and the AFL group had a higher risk of permanent pacemaker (aHR 2.14, 95% CI 1.27 to 3.62).
The RFCA rate increased rapidly during 2001-2010 for AF, AFL and VT. Recurrence was associated with congenital heart disease in PSVT and WPW, and with age in AF and AFL. AFL had a higher risk of permanent pacemaker implantation and new stroke. AF had a higher risk of life-threatening pericardial effusion.
本研究确定了阵发性室上性心动过速（PSVT）、预激综合征（WPW）、心房扑动（AFL）、心房颤动（AF）和室性心动过速（VT）患者接受射频导管消融术（RFCA）后的复发率和并发症发生率。
这项回顾性研究纳入了台湾国民健康保险研究数据库中2001年至2010年期间的射频导管消融术病例。主要结局包括围手术期并发症（心包积液和新发中风）、射频导管消融术复发率和长期结局（高度房室传导阻滞（AVB）和起搏器植入）。
在19475例行射频导管消融术的患者中，PSVT的患病率为56.7%，WPW为13.5%，AFL为9.5%，AF为5.1%，VT为2.7%。在研究期间，AF、AFL和VT的患病率有所上升。在平均4.3年（标准差：2.8年）的随访期内，PSVT、WPW、VT、AFL和AF的复发率分别为2.0%、4.9%、5.7%、5.8%和16.1%。与PSVT组相比，WPW组和AF组入院期间心包积液风险显著更高（校正比值比（aOR）分别为2.98，95%可信区间（CI）为1.24至7.15；aOR为4.09，95%CI为1.90至8.79）；AFL组入院期间新发中风风险更高（aOR为4.07，95%CI为1.39至11.91）；WPW组随访期间高度AVB风险较低（校正风险比（aHR）为0.37，95%CI为0.19至0.71），而AFL组风险更高（aHR为1.74，95%CI为1.17至2.60）；AFL组永久起搏器风险更高（aHR为2.14，95%CI为1.27至3.62）。
2001年至2010年期间，AF、AFL和VT的射频导管消融术发生率迅速上升。PSVT和WPW的复发与先天性心脏病有关，AF和AFL的复发与年龄有关。AFL永久起搏器植入和新发中风风险更高。AF危及生命的心包积液风险更高。
